| Background:Atrial fibrillation(AF),a type of arrhythmia,is one of the most common cardiac rhythm disorders in clinical practice.Recent studies have shown that the prevalence of AF in the Chinese population aged 30 to 85 is 0.65%,while in those over 85,it increases to 0.75%.As the standard of living continues to improve,people’s demand for high-quality life has increased.More and more patients suffering from cardiac arrhythmias are aware of the concept and potential risks of AF.If left untreated,paroxysmal AF may progress to persistent AF,further increasing the risk and difficulty of treatment.Currently,the principle of treating AF is adopting the ABC management model,with A referring to stroke prevention,B to symptom control,and C to controlling cardiovascular complications.The measures for treating AF include rhythm control and rate control,with early rhythm control maximizing patient benefits.Pulmonary vein isolation,as the cornerstone of AF surgery,is performed via either radiofrequency ablation or cryoablation,which are both effective treatment methods.Purpose:The purpose of this study is to compare the efficacy and safety of cryoablation and radiofrequency ablation for persistent atrial fibrillation,and to analyze the factors of postoperative recurrence,in order to provide more effective treatment strategies for patients with persistent atrial fibrillation.Methods:Based on the inclusion and exclusion criteria,a total of 191 patients who underwent cryoablation or radiofrequency ablation for persistent atrial fibrillation(AF)at the First Hospital of Jilin University from January 2019 to June 2021 were continuously enrolled.All patients were ineffective in class I and/or III antiarrhythmic drug therapy.During the one-year follow-up period,7 patients were lost to follow-up,and ultimately,184 patients were included in this study,with 60 patients in the cryoablation group and 124 patients in the radiofrequency ablation group.Results:In the cryoablation group of 60 patients,the immediate success rate was 100%,with a mean operation time of 81.67±2.34 minutes.In the radiofrequency ablation group of 124 patients,the immediate success rate was 100%,with a mean operation time of 168.90±5.20 minutes,which was significantly longer than that in the cryoablation group(P=0.001).In the cryoablation group,6,0,and 1 patients were recorded to have atrial fibrillation(AF),atrial flutter,or atrial tachyarrhythmias at 6,9,and 12 months after the surgery,respectively.The recurrence rates were 10.0%(10/60),0,and 1.7%(1/60)at the respective time points.In the radiofrequency ablation group,16,5,and 5 patients had AF,atrial flutter,or atrial tachyarrhythmias at 6,9,and 12 months after the surgery,respectively.The recurrence rates were 12.9%(16/124),4.0%(5/124),and 4.0%(5/124)at the respective time points,and there was no significant difference in surgical efficacy between the two groups(P>0.05).The overall recurrence rates of the cryoablation group and the radiofrequency ablation group were 11.7% and 21.0%,respectively,with no significant difference(P=0.123).One case of pseudoaneurysm at the puncture site and one case of inguinal hematoma were observed following cryoablation,while a patient undergoing radiofrequency ablation developed a small amount of pericardial effusion.There was no statistically significant difference in the incidence of complications between the two groups(P=1.000).Among the patients who experienced recurrence,4 cases underwent cryoablation and 18 cases underwent radiofrequency ablation during hospitalization.Among the rehospitalized patients,2 patients in the cryoablation group underwent a second ablation,and 9 patients in the radiofrequency ablation group underwent a repeat radiofrequency ablation procedure,with 3 cases achieving sinus rhythm restoration through electrical cardioversion.One patient in the cryoablation group died due to pancreatic mass,and 2 patients in the radiofrequency ablation group were rehospitalized due to cerebral infarction.There was no statistically significant difference between the cryoablation and radiofrequency ablation groups in terms of the rehospitalization rate(6.7% vs 14.5%,P=0.150),rehospitalization cardioversion rate(0.0%vs 2.4%,P=0.552),or reoperation rate(3.3% vs 7.3%,P=0.508).A univariate and multivariate logistic regression analysis was performed to analyze the correlation between recurrence and various factors.It was found that left atrial diameter and duration of atrial fibrillation were independent risk factors for atrial fibrillation recurrence after ablation.Conclusions:(1)The efficacy,safety,and recurrence rate of cryoablation for persistent atrial fibrillation are comparable to those of radiofrequency ablation.(2)Cryoablation has a shorter duration of surgery compared to radiofrequency ablation.(3)Left atrial diameter and duration of atrial fibrillation are independent risk factors for atrial fibrillation recurrence after ablation. |
